HOW-TO SESSION: DENTISTRY
identify subtle pathology or minor defects be- tween teeth.
3. With the lip and/or cheek retracted from the dental structures, the alveolar mucosa, mu- cogingival junction, and gingiva, are inspected for signs of inflammation, irregularities, fistu- lation, and underlying swellings. Palpation can be useful in detecting changes in juga definition or underlying bone; the juga is the bony contouring over the region of the reserve crown and root most distinct in equid incisors. Asymmetry or age inappropriate juga defini- tion can be a sign of underlying pathology.
4. The relative height of surrounding bone at the clinical crown-reserve crown or clinical crown- root junction is examined. The height of the bone encasing the teeth on the mandible and maxilla is referred to as the alveolar ridge. Signs of potential attachment loss (loss of the structures of the periodontium) and decrease in alveolar ridge height include gingival recession, abnormal discoloration of gingiva, severe gingival inflammation, feed packing around or between teeth, subgingival calculus, decrease in height of the dental pa- pillae (interproximal gingival tissue), malpo- sitioning of teeth, increased space between teeth, age inappropriate incisive angle, bleed- ing from around the tooth after irrigation and debridement, and dental mobility.
5. Regions of abnormal gingival contour, gingi- val recession, gingival inflammation, de- creased alveolar ridge height, feed packing, subgingival calculus, and overall suspect peri- odontal structure should be investigated with the periodontal probe. The periodontal probe is used to measure attachment loss of peri- odontal structure from the reserve crown and root. The periodontal probe is slid gently along the outer aspect of the tooth running parallel to the angle of the tooth in the region of the gingival sulcus and possible de- fect. The normal gingival sulcus depth has been reported to be 1 to 5 mm in the horse.8 If the probe measures greater than 5 mm, an area of attachment loss has been iden- tified, and if it runs along the dental struc- ture, it is referred to as a periodontal pocket. Measurements of gingival sulcus depth in otherwise healthy looking tissue is not routine in the equid due to potential gin- gival sulcus trauma that may be caused by the probe in a moving patient.
6. After inspection of all the supporting struc- tures of the tooth, the tooth itself is examined. Dental structure is examined from the periph- ery to the most central visible occlusal aspect of the structure. The condition of the periph- eral cementum, enamel infolding, primary dentin, secondary dentin (overlying the pulp), infundibulum, and infundibular cementum
472 2014 Vol. 60 AAEP PROCEEDINGS
are all examined closely for any signs of defect or loss. Knowing the normal structure and appearance of the clinical crown for all teeth at any age is critical to the ability to identify dental pathology.
7. The dental explorer is used to examine dentin for defects indicating pulp exposure and any portion of the hard dental structure that is in question. The tip of the dental explorer is sharply pointed in order to identify subtle de- fects. The tip of the explorer is properly used at a 90 degree angle to dental hard tissue, and the tip should never contact soft tissue. Us- ing the explorer at a different angulation will decrease the sensitivity of the instrument.
8. If periodontal lesions or clinical crown defects involving the endodontium are identified, ex- traoral and intraoral (if available) radio- graphs are necessary to continue evaluation of the tooth and surrounding anatomy. Acqui- sition and interpretation of these radiographs has been well-described.9,10 In cases where endodontic disease is suspected but no in- traoral pathology identified, radiographs are critical to the evaluation of the health of the tooth. Computed tomography may even be necessary if both radiographs and oral exam- ination do not reveal conclusive evidence of tooth health or disease.
3. Results
The use of adequate lightening, oral irrigation, a full-mouth speculum, dental mirror, periodontal probe, dental explorer, cheek retractor, and radiog- raphy are considered basic equipment for the ade- quate evaluation of periodontal and endodontic structures within the oral cavity. Radiographs are critical to evaluating dental structures for periodon- tal and endodontic health. These facts are well known and published in a vast array of textbooks, review articles, and research articles within and outside of the equine world.
4. Discussion
Periodontal and endodontic disease can affect teeth either independently or together. Depending on the age of the tooth and the extent of pathology, one disease can lead to the other. Severe periodontal disease extending to the tooth root and apex can lead to infection of the pulp, and endodontic disease that results in regional tissue destruction can cause ex- tensive loss of the periodontium. These are called perio-endo and endo-perio lesions, respectively. Usually disease of this extent warrants the extrac- tion of the tooth. Explorers are commonly referred to inappropri-
ately as picks in the equine literature. Explorers are meant to extend and enhance digital tactile sen- sitivity of the user. In order to perform this func- tion, the explorer needs to be very thin and small. The number 23 sheppard’s crook explorer has
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